The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

EFFECTS OF A PROTOCOL BUNDLE ON THE EVIDENCE OF VENTILATOR ASSOCIATED PNEUMONIA IN THE CARDIAC SURGICAL UNIT- A PROSPECTIVE STUDY

Savitha Joseph1, Suresh G. Nair1



Introduction: VAP is the leading cause of death amongst hospital-acquired infections, exceeding the rate of death due to central line infections, severe sepsis, and respiratory tract infections in the non-intubated patient. Reducing mortality due to ventilator-associated pneumonia requires an organized process that guarantees early recognition of pneumonia and consistent application of the best evidence-based practices.

Aim: To evaluate the effectiveness of a protocol bundle on the incidence of VAP in post Cardio Thoracic Surgery patients.

Patients and Methods: This study is a prospective implementation of VAP bundle in 239 patients who were admitted in one year period to our ICU. A multidisciplinary group including Anaesthesiologists, nurses, and respiratory therapists was convened to implement a VAP bundle. All patients receiving mechanical ventilation in our CVTS ICU and IMCU were eligible for study. VAP was identified using standard CDC definitions. The VAP bundle included: Head elevation of 45 degrees, Sedation Vacation, Peptic Ulcer Prophylaxis and Deep Vein Thrombosis prophylaxis. A VAP checklist was used to measure compliance with implementation of the bundle. The checklist was monitored by frontline respiratory therapists.

Results: A total of 239 patients were enrolled in the study over a period of 1 year (January 2007 to December 2007). The incidence of Ventilator associated pneumonia was 41/ 239 episodes i.e.: 17.2%. The mortality rate was 39/239 i.e. 16.3 %. Incidence of VAP is less in patients covered all the 4 bundles. Mortality rate is more in patients with VAP. ICU stay is significantly low in patients without VAP

Conclusion: Use of VAP bundle protocol is an effective preventive strategy against Ventilator Associated Pneumonia in post cardiac surgery patients and this strategy should be mandatory in all patients on ventilators in any ICU